WHO disability grading: operational definitions

Brandsma, J. W.; Brakel, Wim H. van

doi:10.47276/lr.74.4.366

Cited by 103 publications

(61 citation statements)

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“…impaired sensation but no visible impairments. The WHO has suggested a ‘disability classification’ in leprosy patients since 1960 [ 15 ]. However, this classification has been revised twice, as a four-point scale in 1970 and a three-point scale in 1988.…”

Section: Discussionmentioning

confidence: 99%

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Asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain–Barrè syndrome: the first case report of an incidental finding in a slit-skin smear

Nag

Gupta

Sisodia

et al. 2019

Access Microbiology

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Introduction. Lymphatic filariasis (LF) and leprosy are both endemic in India. These diseases are on the World Health Organization (WHO) list of neglected tropical diseases (NTDs), as they affect the most marginalized communities in the world, resulting in deformities and functional limitation. We report the first case of asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain-Barré syndrome. Case presentation. A 55-year-old male who was a farmer by occupation presented to the Neurology Outpatient Department (OPD) of our institute with complaints of weakness in all four limbs for the last 15 days. After admission, a detailed history revealed that the patient had been taking multi-drug therapy (MDT) for leprosy for the previous 6 months. After symptomatic management of the presenting complaints, the patient was sent to the Department of Microbiology for a consultation and sixsite slit-skin sampling. The initial screening of Ziehl-Neelsen (ZN)-stained smears under a 10× objective led to the incidental finding of sheathed structures resembling microfilaria (Mf) on the smear made from ear lobules. In addition, short acid-fast bacilli (AFB) were also observed under the oil-immersion objective. Conclusion. We emphasize that a high index of suspicion and thorough screening of smears by a microbiologist is essential in specimens obtained from any body site.

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Section: Discussionmentioning

confidence: 99%

“…More recently, the individual impairment grades for eyes, hands and feet are summed to compute an ‘eye, hands, feet’ (EHF) score. The EHF sum score is obtained by adding the maximum grade for each of six body sites (eyes, hands and feet), and it can range from 0 to 12[ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain–Barrè syndrome: the first case report of an incidental finding in a slit-skin smear

Nag

Gupta

Sisodia

et al. 2019

Access Microbiology

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“…Leprosy can occur among people of all ages and primarily affects the skin, peripheral nerves, mucosa of the upper airway, and the eyes [ 1 ]. Main symptoms include red or hypopigmented skin patches with thickened nerves, definite loss of sensation, muscle weakness and numbness in hands and feet (disability grade 1) and, in a later stage, deformity of hands and feet and vision loss (disability grade 2) [ 1 , 2 ]. Leprosy can also be present with no anaesthesia and no visible deformity or damage (grade 0) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Main symptoms include red or hypopigmented skin patches with thickened nerves, definite loss of sensation, muscle weakness and numbness in hands and feet (disability grade 1) and, in a later stage, deformity of hands and feet and vision loss (disability grade 2) [ 1 , 2 ]. Leprosy can also be present with no anaesthesia and no visible deformity or damage (grade 0) [ 2 ]. Clinical manifestation is usually enough for prompt diagnosis of leprosy.…”

Section: Introductionmentioning

confidence: 99%

Geospatial epidemiology of leprosy in northwest Bangladesh: a 20-year retrospective observational study

Bulstra

Blok

Alam³

et al. 2021

Infect Dis Poverty

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Background Leprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms that enable hotspots to emerge, are not yet fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a country with one of the highest leprosy endemicity levels globally. Methods We used data from four high-endemic districts in northwest Bangladesh including 20 623 registered cases between January 2000 and April 2019 (among ~ 7 million population). Incidences per union (smallest administrative unit) were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000–2009, 2005–2014 and 2010–2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e., relative risk (RR) of one to two), medium (i.e., RR of two to three), and strong (i.e., RR higher than three) hotspots. Results New case detection rates dropped from 44/100 000 in 2000 to 10/100 000 in 2019. Statistically significant hotspots were identified during all timeframes and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1930 cases among less than 1% of the population), significantly more child cases (i.e., below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively. Conclusions Leprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that leprosy hotspots represent areas of higher transmission activity and are not solely the result of active case finding strategies.

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“…The World Health Organization (WHO) defines ‘disability’ as an umbrella term that covers physical impairment, activity limitation, and participation restriction [ 4 ]. In leprosy, an alternative definition of disability has traditionally been used; grades 0, 1, and 2 disability [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Revised estimates of leprosy disability weights for assessing the global burden of disease: A systematic review and individual patient data meta-analysis

et al. 2021

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Background Leprosy is a chronic bacterial infection caused by Mycobacterium leprae, which may lead to physical disability, stigma, and discrimination. The chronicity of the disease and disabilities are the prime contributors to the disease burden of leprosy. The current figures of the disease burden in the 2017 global burden of disease study, however, are considered to be under-estimated. In this study, we aimed to systematically review the literature and perform individual patient data meta-analysis to estimate new disability weights for leprosy, using Health-Related Quality of Life (HRQOL) data. Methodology/principal findings The search strategy included all major databases with no restriction on language, setting, study design, or year of publication. Studies on human populations that have been affected by leprosy and recorded the HRQOL with the Short form tool, were included. A consortium was formed with authors who could share the anonymous individual-level data of their study. Mean disability weight estimates, sorted by the grade of leprosy disability as defined by WHO, were estimated for individual participant data and pooled using multivariate random-effects meta-analysis. Eight out of 14 studies from the review were included in the meta-analysis due to the availability of individual-level data (667 individuals). The overall estimated disability weight for grade 2 disability was 0.26 (95%CI: 0.18–0.34). For grade 1 disability the estimated weight was 0.19 (95%CI: 0.13–0.26) and for grade 0 disability it was 0.13 (95%CI: 0.06–0.19). The revised disability weight for grade 2 leprosy disability is four times higher than the published GBD 2017 weights for leprosy and the grade 1 disability weight is nearly twenty times higher. Conclusions/significance The global burden of leprosy is grossly underestimated. Revision of the current disability weights and inclusion of disability caused in individuals with grade 0 leprosy disability will contribute towards a more precise estimation of the global burden of leprosy.

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WHO disability grading: operational definitions

Cited by 103 publications

References 0 publications

Asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain–Barrè syndrome: the first case report of an incidental finding in a slit-skin smear

Asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain–Barrè syndrome: the first case report of an incidental finding in a slit-skin smear

Geospatial epidemiology of leprosy in northwest Bangladesh: a 20-year retrospective observational study

Revised estimates of leprosy disability weights for assessing the global burden of disease: A systematic review and individual patient data meta-analysis

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